NSG 251 Exam 2 Blueprint SP23

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Marian University *

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Chemistry

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Dec 6, 2023

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NSG 251: Pharmacology and Dosage with Lab Exam 2: Test Blueprint Spring 2023 Exam 2 40 questions worth 2 points each Chapters 38 & 39 Basic Concepts to Understand:  Empiric versus definitive therapy- o EMPIRIC THERAPY: Antibiotic therapy prior to results of blood cultures is known as empirical (broad- spectrum antibiotic that kills a little bit of everything) o DEFINITIVE THERAPY: If empirical is ineffective against organism, then a specific sensitive antibiotic is substituted. This is knowns as definitive therapy. (A narrow spectrum antibiotic that only kills specific bacteria, narrow spectrum therapy helps reduce bacterial resistance.  Superinfection o Happens when normal flora is killed by antibiotic therapy and replaced with opportunistic pathogens  Peak and trough drug levels o Peak is the highest therapeutic effect o Trough is the lowest therapeutic effect.  Importance of cultures:  Hypersensitivity reaction and nurse action : o Can be immediate or delayed (After 72HR). MUST STOP MEDICATION. o If giving by IV, stop antibiotic infusion IMMEDIATELY, but leave IV line in place. o Contact prescriber and monitor patient o WATCH FOR: Wheezing/ SOB, swelling of tongue or hands, itching, or rash 1

Meds Sulfonamides o Basic understanding of how it works  Bacteriostatic antibiotics that act on the DNA synthesis (by blocking folic acid) o Uses (what does it treat).  Broad spectrum (wide variety of gram (+) and (-) bacteria), concentrates in the urine, effective against UTI, community acquired MRSA o Adverse effects  Delayed rash preceded by fever  Photosensitivity (light sensitivity)  Low RBC, WBC, platelet counts o Important interactions/contraindications-  Allergy to sulfonamides or sulfites. NEVER COMBINE W/ CELECOXIB (Contains a derivative of sulfa)  Avoid in pregnancy and infants <2 years old  Interactions w/ warfarin (coumadin) causing hemorrhage, Sulfonylurea causing hypoglycemia, and phenytoin (Dilantin) causing toxicity o Nursing Process (What are you going to assess, planning, implementation (education), evaluation (monitoring for therapeutic effects).  Obtain baseline, CBC  Sunscreen/ limiting exposure to sun/ NO TANNING  Use back up method of birth control  Increase fluid (preferably water) 2-3L  Take oral medication w/food to minimize nausea  Report rash, bleeding, shortness of breath, abdominal pain, or fever to HCP Penicillin (beta-lactam)  All drug in this class end with “cillin” BACTERICIDAL o Basic understanding of how it works.  Inhibit cell wall synthesis leading to eventual cell lysis o Uses (what does it treat).  Prevention and treatment of gram (+) infections  Little effect on gram (-) EXCEPT extended-spectrum penicillin which has both gram (+) and (-) anaerobic coverage. o Adverse effects.  Suppression of bone marrow: low RBC, WBC, platelets  Hyperkalemia, hypernatremia  Lethargy, anxiety, depression, seizures  Allergic reaction  Cross reactivity w/cephalosporin possible o Important interactions/contraindications.  Known allergy  Many interactions- positive killing affect when combined w/aminoglycosides  Enhances effect of warfarin (increased bleeding risk)  Decreased effect of oral contraceptive. o Nursing Process (What are you going to assess, planning, implementation (education), evaluation (monitoring for therapeutic effects).  Use back up birth control 2

 Some penicillin contains large amount of sodium and/ or potassium: monitor electrolyte levels  Adjust dosage for pt w/renal impairment  Assess pt for asthma, aspirin allergy, and sensitivity to cephalosporin as these are associated w/ high risk for penicillin allergy.  Administer oral penicillin with water (NEVER W/CITRUS JUICE, FRUIT JUICE, TOMATO JUICE, OR SODA- WHICH DEACTIVE THE ANTIBIOTIC)  Give w/small snack to reduce nausea Cephalosporin (5 different generations- vary in effectiveness)  Example: cefazolin o Basic understanding of how it works  Bactericidal antibiotics that act on the bacterial cell wall synthesis leading to defective walls and eventual cell lysis o Uses (what does it treat)  Treatment of a variety of bacterial infections o Adverse Effects  Most common include mild diarrhea, abdominal cramps, rash, pruritus (itching) o Important interactions/contraindications.  May have cross-sensitivity implication w/other beta-lactam medications.  Interact w/ alcohol to produce a disulfiram-like reaction causing cramps, nausea, vomiting, diaphoresis, pruritus, headache, and hypotension  Avoid alcohol up to 72 hr AFTER last dose  Decreased effect of oral contraceptives  Pregnancy category B o Nursing Process (What are you going to assess, planning, implementation (education), evaluation (monitoring for therapeutic effects).  Use back up method of birth control  Give w/food to decrease nausea Macrolides Example: Erythromycin  Shorter duration of action compared to azithromycin (Zithromax): must be dosed more frequently  Erythromycin also stimulates GI peristalsis and may be helpful for delayed gastric emptying, may be used prior to passage of feeding tubes  Macrolides are highly protein bound o Basic understanding of how it works.  Bacteriostatic, bactericidal in high concentration  Interfere w/protein synthesis o Uses (what does it treat)  Upper and lower respiratory tract infections  Skin and soft tissue infection  STIs (Sexually transmitted infections)  Lyme disease  Can be used as a replacement antibiotic for patient w/beta-lactam allergy o Adverse effects.  Palpitations and chest pain. Long QT syndrome  Heartburn, gas  Hepatotoxicity, jaundice 3

 Tinnitus and hearing loss o Important interactions/contraindications.  Allergy  Increased risk of warfarin, carbamazepine, theophylline, and digoxin toxicity  Reduces effect of oral contraceptives  Do not combine with other drug that prolong the QT interval  Do not use with statins (cholesterol lowering medications) causes toxicity o Nursing Process (What are you going to assess, planning, implementation (education), evaluation (monitoring for therapeutic effects).  Monitor IV site if macrolides given via this route  Use back up birth control  Monitor for changes in hearing  Monitor heart rate and rhythm  Assess for liver function and review liver enzymes  Avoid fruit juice prior to or after administration Tetracyclines o Basic understanding of how it works.  Bacteriostatic  Inhibits protein synthesis o Uses (what does it treat).  Treats a wide variety of gram (+) and (-) infections  Lyme disease  Syphilis, pelvic inflammatory disease  Acne  H pylori (cause of GI ulcer)  Can be used as a PCN substitute for patient with allergy o Adverse effects.  Discoloration of tooth enamel and enamel hypoplasia  Retardation of skeletal development of fetus  Photosensitivity  Thrombocytopenia, hemolytic anemia o Important interactions/contraindications.  Allergy  Milk, antacid, magnesium, and iron block absorption  Do NOT give to child under 8 as drug has affinity for calcium and will permanently discolor adult teeth  Do not give in pregnancy  Increases effect of anticoagulants  Decrease effect of oral contraceptive o Nursing Process (What are you going to assess, planning, implementation (education), evaluation (monitoring for therapeutic effects).  Skin protection- sunblock/ limit exposure to sun  Monitor platelet count  Assess for signs of bleeding  Monitor RBC, WBC, and HCT counts  Do NOT take with antacids, antidiarrheal drug, calcium/dairy enteral feedings or iron: reduces drug absorption . 4

Aminoglycosides  Example: gentamicin o Basic understanding of how it works.  Concentration-dependent killing, above minimal concentration, even for a short time  Prevents protein synthesis  Has a post-antibiotic affect: prolonged period of drug affect even after short-term drug exposure (this allows aminoglycosides to be given as a once daily regimen)  This affect enhanced with higher perk serum concentration and concurrent administration of beta-lactam antibiotics o Uses (what does it treat).  Serious gram-negative infection  Prophylaxis for procedures of the GI or genitourinary tract to prevent bacteremia o Adverse effects.  Nephrotoxicity  Ototoxicity (hearing and balance)  Headache, fever  Superinfection o Important interactions/contraindications.  Allergy  Pregnancy: category C and D (may produce irreversible bilateral congenital deafness)  Administer with caution in premature and full-term neonates due to renal immaturity  Nephrotoxicity enhance when given concurrently with other nephrotoxic drug.  Concurrent use with loop diuretics increases risk of ototoxicity  May reduce vitamin K (associated with clotting) through loss of normal flora o Nursing Process (What are you going to assess, planning, implementation (education), evaluation (monitoring for therapeutic effects).  Requires serum drug level monitoring via peak and trough levels: trough must be above minimal concentration to be effective and peak must be below toxicity level  Once a day dosing: draw trough 8-12 hours after the last dose  Traditional dosing (3x/day) draw trough immediately prior to the next dose and draw the peak 30-60 min after the next dose has infused.  Monitor for changes in hearing and balance: often NOT reversible  Monitor hydration  Encourage fluid intake up to 3L/day  Monitor BUN, creatinine, creatinine clearance, potassium level, urine color, quantity, urinary casts, proteinuria (effect on renal system is usually reversable)  Monitor for weakness  Encourage intake or yogurt, buttermilk, or probiotics  IM: Give deep and slow into the ventrogluteal  Monitor IV access for phlebitis Quinolones (Fluroquinolones) Example: ciprofloxacin- All generic names in this class end in “floxacin” o Basic understanding of how it works  Potent broad-spectrum bactericidal  Mostly gram (-) and some gram (+) organisms  Inhibit DNA replication  Excellent oral absorption: comparable to IV injection 5

o Uses (what does it treat)  Complicated UTI: Quinolones are excreted unchanged by the kidneys and have gram (-) coverage  Respiratory infection  GI infection  Skin, bone, and joint infections  Anthrax o Adverse effects.  Superinfection  Long QT  Tendonitis and tendon rupture: FDA: BOX WARING  More common in older adults, patient with renal failure, and concurrent use of glucocorticoid drug  These effects continue even after the drug has been stopped  CNS effects including seizures depression, suicidal ideation: FDA BOX WARNING  Photosensitivity  May cause live injury  Blood sugar variation o Important interactions/contraindications.  Growing bacterial resistance with the class  Allergy  Dysthymias may occur if used with class la and lll (amiodarone) antiarrhythmic drug  Enhanced effect of anticoagulant warfarin (coumadin) due to reduced vitamin K levels o Nursing Process (What are you going to assess, planning, implementation (education), evaluation (monitoring for therapeutic effects).  FDA: BOX WARNING: DO NOT PRESCRIDE UNLESS NO OTHER EFFECTIVE ANTIBIOTIC CLASS  Monitor heart rate and rhythm  Encourage yogurt, buttermilk, or probiotics  Report watery diarrhea, yeast in moth or vagina  Monitor for tendon swelling and pain  Monitor for sudden change in mood: depression and suicidal ideation  Monitor liver enzymes and blood glucose levels  Do not administer with antacid, calcium, dairy products, magnesium, iron, zinc, sucralfate, and enteral feeding  Take these 1 hour prior to or 1hour after dose (tube feeding)  Protect skin: sunscreen/ limit exposure to sun Metronidazole o Basic understanding of how it works.  Disrupts DNA synthesis o Uses (what does it treat).  Effective against anaerobic bacteria  Effective against protozoal infection  Treat intrabdominal infection  Treat gynecological infection o Adverse effects  Dizziness  Headache 6

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